BACKGROUND:Gluteus medius (GM) dysfunction is associated with many musculoskeletal disorders. Rehabilitation exercises aimed at strengthening GM appear to improve lower limb kinematics and reduce pain. However, there is a lack of evidence to identify which exercises best activate GM. In particular, as GM consists of three distinct subdivisions, it is unclear if GM activation is consistent across these subdivisions during exercise. The aim of this study was to determine the activation of the anterior, middle and posterior subdivisions of GM during weight-bearing exercises.METHODS:A single session, repeated-measures design. The activity of each GM subdivision was measured in 15 pain-free subjects using surface electromyography (sEMG) during three weight-bearing exercises; wall squat (WS), pelvic drop (PD) and wall press (WP). Muscle activity was expressed relative to maximum voluntary isometric contraction (MVIC). Differences in muscle activation were determined using one-way repeated measures ANOVA with post-hoc Bonferroni analysis.RESULTS:The activation of each GM subdivision during the exercises was significantly different (interaction effect; p < 0.001). There were also significant main effects for muscle subdivision (p < 0.001) and for exercise (p < 0.001). The exercises were progressively more demanding from WS to PD to WP. The exercises caused significantly greater activation of the middle and posterior subdivisions than the anterior subdivision, with the WP significantly increasing the activation of the posterior subdivision (all p < 0.05).DISCUSSION:Posterior GM displayed higher activation across all three exercises than both anterior and middle GM. The WP produced the highest %MVIC activation for all GM subdivisions, and this was most pronounced for posterior GM. Clinicians may use these results to effectively progress strengthening exercises for GM in the rehabilitation of lower extremity injuries.

We reviewed the effect of adding maraviroc on CD4 cell counts in nine patients on antiretroviral therapy with full viral suppression but impaired CD4 cell recovery. There were no significant differences in changes in CD4 cell count, percentage of CD4 cells, or in the ratio of CD4/CD8 cells at 30 days and 25 weeks of maraviroc therapy. Plasma endotoxin levels measured in four patients before and during maraviroc treatment also showed no significant differences.

18579 Background: There is evidence that daily intrarectal amifostine can protect rectal mucosa during prostate cancer treatment. Instruments more sensitive than the RTOG score may discriminate small but clinically important reductions in proctitis, however these tools need further evaluation. This study used both the RTOG GI toxicity score and expanded prostate cancer index composite (EPIC), a patient-administered quality of life instrument, to evaluate toxicity. Methods: In this pilot study, patients with localized prostate cancer were given daily amifostine (MedImmune, INC., Gaithersburg, MD) which was placed per rectum 30–45 min before 3D conformal radiation (66–76 Gy in 2 Gy fractions to a volume based on PSA, Gleason score and clinical stage). The first 18 patients enrolled received 1gram of amifostine and the next 12 patients were given 2 grams. Toxicity was assessed at baseline, 5, and 7 weeks during treatment and 3, 6, 12, 18, and 24 months after radiation and amifostine treatment. RTOG grading, an EPIC score and proctoscopic examination were done. The EPIC questionaire is a validated instrument that consists of 50 quality of life questions related to urinary, bowel, sexual and hormonal domains. Two subsets of the bowel domain were used: “bowel function” (BF) targets symptom severity and “bowel bother,” (BB) assesses quality of life subscales. Results: Previously reported results demonstrate a clear trend towards protection from rectal toxicity using 2 gm as compared to a 1 gm amifostine dose. Here, we report that the EPIC-BF and EPIC-BB scores are both highly correlated with the RTOG toxicity score with a pearsons coefficient of 0.98 and 0.97 respectively at a median follow up of 24 mos. There was no significant change in the RTOG GI toxicity score over the course of treatment for either amifostine dose group. There was a statistically significant decrease in EPIC-BF score at 7 weeks (p = 0.04) and the EPIC-BB score showed a trend toward improvement (p = 0.07) at the same time point. The EPIC scores at all other time points were not statistically different from baseline. Conclusions: The EPIC score may be a more sensitive measure to detect acute toxicity associated with prostate cancer treatment but needs further investigation in the acute setting. No significant financial relationships to disclose.

New therapies for vancomycin-resistant Enterococcus faecium (VREF) infections are urgently needed. We describe the treatment of 15 patients with VREF infection with quinupristin/dalfopristin (RP 59500), a new injectable streptogramin antibiotic. Primary infections treated were bacteremia (4), urinary tract (4), intraabdominal (5), otitis externa (1), and meningitis (1). Minimum inhibitory concentrations for quinupristin/dalfopristin ranged from 0.5 microgram/ml or less to 2 micrograms/ml, and minimum bactericidal concentrations were greater than 64 micrograms/ml for all VREF isolates tested. Peak serum inhibitory titers following infusion of quinupristin/dalfopristin ranged from 1:8 to 1:64; all bactericidal titers were less than 1:2. Development of resistance to quinupristin/dalfopristin during therapy was not observed. The only drug-related adverse effect noted was phlebitis in 4 patients; all had received quinupristin/dalfopristin by peripheral venous infusion. Three patients had clinical and bacteriologic cures. Relapses occurred in 5 patients with recovery of VREF from infected sites in post-treatment cultures. Ten patients died of severe underlying disease; VREF was believed to contribute directly to the death of only 1 patient. While evaluation of clinical efficacy was complicated by the severity of underlying disease in patients with VREF infection, our experience suggests that quinupristin/dalfopristin is a safe and potentially useful agent for the treatment of VREF infections.

The minimum inhibitory concentrations of antibiotics for bacterial pathogens are derived from broth suspensions (broth dilution) and from nutrient surfaces (agar dilution). These concentrations may not apply when bacteria are on a nonnutrient surface such as in a foreign body infection. We compared bacteria (Staphylococcus epidermidis and Escherichia coli) broth suspension MBCs with MBCs of the same bacteria when on a nonnutrient surface in broth the growing and nongrowing phases. Bacteria growing on cotton surfaces were much less susceptible to antibiotic killing than when freely suspended in the liquid nutrient. These results alone, independent of host factors, would explain the failure of antibiotics to eradicate infections involving bacteria on foreign body surfaces. The resistance of bacteria to antibiotic killing is not caused by a lack of antibiotic penetration to the site of the bacteria, but by an altered state of the bacteria when they are associated with a surface.

The past 5 years have witnessed a dramatic increase in the isolation of vancomycin-resistant enterococci from hospital- ized patients (4, 5). Although enterococci have generally been regarded as having limited virulence, their intrinsic resistance to antibiotics and the ease with which they adapt to their environmentandacquireresistancetoantibioticsprovidethem with distinct survival advantages over other more susceptible bacterial pathogens. Clinical isolates of enterococci that not only are resistant to high concentrations of vancomycin but actually require vancomycin for growth have recently been described (9, 12, 22). This phenomenon may represent the ultimate in microbial evolution in response to an antimicrobial agent. We report the isolation and characterization of vancomycin- dependent Enterococcus faecium (VDEF) from the stool of a patient who had received oral vancomycin therapy for the treatmentofpresumedClostridiumdifficilecolitis.Theoraluse of vancomycin has been associated with the isolation of fecal vancomycin-resistant E. faecium (VREF) (20); however, the isolation of E. faecium requiring vancomycin for growth from the stool of a patient after oral administration of vancomycin has not been reported. Case report. An 82-year-old man with fever, cough, and diarrhea was admitted from a nursing home. He had received oral ciprofloxacin and amoxicillin for 10 days prior to admis- sion. A physical examination revealed crackles over the right lower lungfields. A right lower lobe infiltrate was present on a chest radiograph. The stool was positive for occult blood. Em- piric treatment with intravenous ceftazidime for pneumonia and oral vancomycin, 125 mg every 6 h, for presumed C. dif- ficilecolitis was begun. AC. difficiletoxin assay was requested, but the sample collected was insufficient for testing. Stool collected from this patient on admission as part of a surveillance study for vancomycin-resistant enterococci (23) grew VREF. After 10 days of oral vancomycin treatment, E.

The emergence of vancomycin-resistant Enterococcus faecium (VREF) has produced a therapeutic dilemma. The colonization of the intestinal tract with VREF may predispose patients to infections by this organism and may contribute to its nosocomial spread. It is reasonable to attempt to eradicate VREF from colonized patients. The optimal regimen, however, is unknown and this study was designed to evaluate the efficacy of oral regimens of vancomycin and bacitracin for the elimination of VREF from the enteric tract. Enterococcal isolates were tested for susceptibilities to vancomycin, bacitracin, and ampicillin with median minimum inhibitory concentrations of > 512 micrograms/ml, 10 units/ml, and 128 micrograms/ml, respectively. All patients were given an initial trial of oral vancomycin 125 mg every 6 h for 10 days. Those who failed oral vancomycin were then given oral bacitracin 25,000 units every 6 h for 10 days due to its favorable in vitro activity. VREF was eradicated from the stools of 42% of patients (eight of 19) receiving oral vancomycin as compared with all eight patients receiving oral bacitracin (P < 0.01). The organism recurred in two bacitracin patients (25%) 8 and 20 days after completion of therapy. Whether prior vancomycin therapy predisposed patients to colonization by VREF was also examined. Ten (53%) of 19 patients had received prior vancomycin therapy before isolation of VREF from the stool. Our data suggest that oral bacitracin may be an effective alternative to commercially available oral vancomycin for the eradication of VREF from the enteric tract.

Journal Article Susceptibility of resistant Enterococcus faecium to unusual antibiotics Get access ROBERT H. K. ENG, ROBERT H. K. ENG aInfectiaus Disease Section, Medical ServiceEast Orange, NJ 07018-1095, USAcDepartment of Medicine New Jersey Medical SchoolNewark, NJ 07103, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar KIMMIE NG, KIMMIE NG aInfectiaus Disease Section, Medical ServiceEast Orange, NJ 07018-1095, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar SHARON M. SMITH SHARON M. SMITH bMicrobiology Section, Laboratory Service, Department of Veterans Affairs Medical CenterEast Orange, NJ 07018-1095, USAdDepartment of Laboratory Medicine and Pathology. New Jersey Medical SchoolNewark, NJ 07103, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Antimicrobial Chemotherapy, Volume 31, Issue 4, April 1993, Pages 609–610, https://doi.org/10.1093/jac/31.4.609 Published: 01 April 1993

Antibiotics may inhibit bacterial growth or may kill bacteria by inhibiting cell wall synthesis or protein synthesis. The amount of endotoxin released during antibiotic action has been found to be clinically important. Nine antibiotics, representing seven classes, were studied for the amounts of endotoxin released during their action on susceptible strains of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa. Staphylococcus aureus, which produces no endotoxin, was used as a control organism. Aztreonam induced the highest release of endotoxin, whereas other antibiotics such as imipenem and the quinolones induced the lowest release of endotoxin. Although the quantities of endotoxin released are not easily explained from the established mechanisms of antibiotic action, our findings may have implications for therapy of the acutely ill, septic patient in whom release of large quantities of endotoxin may be catastrophic.

Cherubin, Charles E.; Smith, Sharon M.; Eng, Robert H. K.; Pudi, Krisna Author Information

The attainable inhibitory ratios (AR) for oral antibiotics were calculated by using literature reports of concentrations attained in respiratory secretions for amoxicillin-clavulanic acid (AMX/CA), ofloxacin (OFL), L-ofloxacin (L-OFL), cefuroxime (CEFU), ciprofloxacin (CIP), and enoxacin (ENO), and using microdilution minimum inhibitory concentration data of these antimicrobials against the common bacterial respiratory pathogens. AR of each antibiotic against the pathogens was expressed as multiples of the MICs achieved at the respiratory site. Bacteria tested included Staphylococcus aureus, group-A and group-B streptococci, Viridans streptococci, Streptococcus pneumoniae, Brahamella catarrhalis, Klebsiella pneumoniae, Eikenella corrodens, Haemophilus influenzae, H. parainfluenzae, Pseudomonas aeruginosa, and Legionella pneumophila. The antimicrobials with the narrowest spectrum of activity were amoxicillin-clavulanic acid and cefuroxime which had high attainable inhibitory ratios only against Gram-positive cocci. Ofloxacin and L-oflaxacin were among the quinolones with the highest overall ARs against respiratory pathogens, including, L. pneumophila, H. influenzae, and B. catarrhalis. All agents showed no, or inadequately low ARs for P. aeruginosa.